Eating elephants

   The answer to the tongue-in-cheek question, “how do you eat an elephant” is- “one bite at a time.” This begs the question of just why one would want to eat an elephant in the first place but in making a point, I think one came take some license with analogies.

The premise behind this question is that large jobs, tasks, projects, etc. are best approached by breaking them down into smaller, manageable parts. While perhaps not universally applicable, it does come close. I couldn’t think of a situation in which this advice might not apply  in some way.

My daughter, Olivia, is a second year medical student at the University of Miami Miller School of Medicine, my alma mater. She is an achiever. Notice I didn’t say “over” achiever, as this implies that there is something wrong with not just trying to do your best, but doing things well. This week and weekend, she is facing a major examination on the current academic block, which is renal (kidney) physiology and clinical renal medicine. Renal is one of the most complicated areas of study in medical school and I have always held nephrologists (kidney specialists) in high regard. She is facing the daunting task of reviewing  hours and hours of videotaped lectures as well as voluminous notes, each page of which is full of formulas, equations, and related information. I remember renal well from my days in med school. It is overwhelming. She is worried because of the sheer volume of material and its complexity since she wants to not just pass this section but do well.

 

 What advice would I give to her, since, supposedly, I am older and wiser and have been through this before? I would say don’t focus on the elephant, i.e. the entire body of information you are responsible for learning. Instead, break it down into manageable packets. Go through each page, one by one, and each lecture, the same way. Emphasize understanding over pure recall. If you understand the material, recall will be much easier. Trust what you have learned up to this point. Budget your time and your energy. Every student has the same amount of material to study and the same time frame in which to do that. No one can ask you to do more than your best effort. 

 

  

One of Olivia’s problems is that she has always looked around at her classmates in high school and college with confidence that she could rise to the top of any class with enough effort and determination. In medical school, however, your classmates are the “cream of the crop” from universities all over the country and only a few can be at the top. It is a paradigm shift in thinking for most students. It certainly was for me.

I want to tell her, “you will do fine”. I truly believe that. Her entire academic career up to now has been one of always doing well, indeed, very well. But, as I say that, I am convicted by my own words. This ironman thing is kicking my butt, physically yes, but especially mentally. Despite my training and preparation and the assurances of my coach, I am having a great deal of trouble coming to grips with the idea that I will do “fine”. “Fine”, by the way, to me simply means finishing. Forget time goals, qualifying for Kona, age group podium finishes, and the like. I just want to get done before the cutoff of 17 hours. That will be victory and anything better will be icing on the cake. Like Olivia, I can’t seem to stop looking around me and thinking that all these other participants are younger, stronger, and faster than me, and they have probably trained harder. I really wonder how I will stack up against my peers and, truth be told, against those who are older than me. I keep looking at the whole elephant rather than breaking it into smaller pieces.
  

 As I look back I can see a number of milestones that I have achieved and surpassed over the past 11 months: first 4000+ yard swim, first solo century on the bike at 16+ mph, running 15+ miles at 9:28 min/mi. I can see the changes in my body. All good stuff and objective signs of progress.

I guess if Olivia is going to believe anything I say, I need to have the courage of my convictions, so…..Olivia, we are going to be fine.

Exhaustion

My thoughts right now are on being tired. I mean really tired. So tired that exhaustion becomes your alternate universe. In that moment it is where you live, all consuming, a wormhole tunnel with no light at the end, in fact, no end.  I remember such a feeling once in my professional life. In general surgery residency, feeling tired was the normal state of affairs. I use to fantasize about being able to sleep as much as I wanted, and it WAS a fantasy because it never happened. My daytime sleepiness was such that I even went to Stanford University’s sleep laboratory to be checked for narcolepsy. For two days I was asked to try to fall asleep several times a day while my brain waves were monitored with electrodes stuck all over my head. I looked like a true bionic man.  .        The verdict? I needed to get more sleep!

Once, as a 4th year resident on the neurosurgery rotation in San Francisco’s main trauma hospital I was continuously awake, working up patients, going to the operating room, rounding on patients in neuro intensive care unit for 36 hours. At the end of the day, I went home, a one hour drive from San Francisco to my apartment in Oakland, CA. No sooner did my head hit the pillow than the phone rang. I was informed by the chief neurosurgery resident that the other junior resident was sick and I had to come back in immediately to cover his shift. I drove back in a fog and worked another 24+ hours. By the end of that time I was beyond tired. I was so tired that my sleepiness, ironically, went away. The chief resident had been up operating almost continuously too (this was in the day before the 80 hour work week restriction for residents). At one time, in the early morning hours, we were sitting together in the intensive care unit giggling like two silly teenage girls over just about anything. .     I had never been so tired in my life……..until now.

 This week, I did an intense strength session at the National Training Center on Tuesday. It was one of those where, at the end of each session, I was literally gasping, my breath coming in loud whoops as I tried to suck in enough air to get caught up. Each session ended in failure, or near failure, of the muscle groups involved. I wasn’t sure I had the strength to get to my car and drive home. The next day, I did an interval session on the treadmill. It involved six 400 yard segments at a near sprint, with 30 seconds recovery running between each. Again, at the end I was tapped out. Then, Thursday called for a 2 ½ hour run. I made the first half but around mile 11, I was suddenly hit with exhaustion of such intensity that I could not run another step. There is a reason it’s called “hitting the wall”. Total exhaustion is, indeed, a wall. I started walking, trying to keep up a good pace. Usually, I can recover fairly quickly, but this time every time I tried to resume a slow jog, I only lasted a minute or two. I basically walked the rest of the way home. My breathing did normalize for 45 minutes after I got there.

This was a reality check of what it feels like to be beyond tired, beyond exhausted, even. I am expecting to feel this way in about 4 weeks. I only hope that I will be mentally prepared for that, and that I will have banked enough time earlier in the day that, if I have to, I can walk “home” to the finish.  Time is my concern now because I have resolved that, come what may, I will not quit moving forward. In fact that will be my “mantra”: keep moving, don’t stop moving. It’s only 17 hours of effort. I have said much the same at times in my professional career. Some days just never seem to end. To get through them, you have to tell yourself, "this won't last forever; there will be an end to this day". Somehow, it gets you through. I think a big part of life is learning to get through the hard times, knowing there will be an opportunity for rest later.  .      

It’s easy to stop moving when. to move, is uncomfortable. Many of the patients I see every day have basically done that; stopped moving for most of their lives, which are little more than a steady progression from sedentary place to another. Exercising is not easy. If it was, everyone would do it. If there is one overarching problem with our society today, it is that it is too sedentary. This leads to a host of ills: metabolic syndrome, obesity, muscle mass loss, etc. These, in turn, lead to a plethora of illness that are sinking our economy in a sea of red ink to pay for their care. “I’ve fallen and I can’t get up” is more than a humorous catch phrase. It describes a large proportion of older adults.

 After this tri is over, I don’t plan to train like this again, but I do plan to keep moving………..

Greatness eludes me and its my parents fault

  Greatness eludes me. You see, I suffer from an insurmountable handicap; I had a wonderful childhood. No, it wasn’t perfect. I suspect that few childhoods are. There are always traumatic moments along the way, and I had my share. However, mine was pretty darn good. In fact, looking back, I find it hard to recall any really stinging traumas that have produced any enduring sense of loss, regret, injury, etc. in my mind. What I do recall is lots of fun, great experiences, and, in general, an overarching sense of security for most of my life.

My parents, for all their flaws, were devoted to each other and to my sisters and me. My interests in hobbies, sports, careers, my friendships, were all encouraged and supported. My parents passed on to me their faith in a God who values each individual without regard to their shortcomings. Expressions of love, support, respect, and outward expressions of these were common in my family. In short, I had love, security, and self-worth passed on to me in spades. It really messed me up in trying to achieve greatness.

 The ancient Greeks had a saying, or so I have read somewhere: “no great thing comes into the life of men without a curse”. Take, for example, technology, e.g. personal computers.     No one disputes how much they have brought into our lives, however, they can really screw it up too. Online addiction to gaming, gambling, and porn; cyber-relationships that wreck marriages   ; spam; viruses; etc. They are even tied to the epidemic of obesity in kids who now spend time in front of computer screens that they used to spend outdoors.   I think there is another side to that coin: greatness often comes out of a “cursed” situation.

 Doesn’t it seem that so many great accomplishments come out of lives that were miserable? Stories of people achieving greatness in sports, entertainment, business, and science to compensate for awful childhoods and/or to impress unloving, unsupportive parents are so common as to border on cliché.  Two examples from my recent readings* come to mind. Alberto Salazar, the great marathoner   , and Dave Scott, 6 time Kona Ironman champion   , both trying to impress fathers who withheld their love and/or support during their childhoods.

 Both men put forth superhuman effort and endured unimaginable pain and discomfort to achieve their goals, at a cost that may never be fully appreciated. I think about this sometimes when I am in the middle of a hard workout. When I am really tired, uncomfortable, sore, or just plain unmotivated, I try to summon up some compelling reason to keep putting myself through this and I get……..well, not much. There is just not much of anything I am trying to prove to anyone at this point in my life. Although I will never achieve greatness in any area, I have enough accomplishments of which I am proud that I have no real incentive to really push myself through those moments and it is easy to say, “oh, the heck with it”, and back off.

 Today, to assess my fitness level, I planned a personal half ironman brick- 1.2 mi swim, 56 mi bike ride, and 13.1 mi run. I did OK with the swim, although slower than I would have liked. The bike portion went fine with an average speed over 16 mph, which is what I am shooting for. Then came the run portion. By then it was hot and I was tired (I am sure I will be a lot more tired after swimming and biking twice those distances in the full ironman). I ran the first two miles, then just ran out of gas, pretty much walking after that, and gave up after 7.1 miles. I was exhausted, could not catch my breath, and my legs felt shredded. Even power walking was an effort and I imagined trying to walk another 19.5 miles, and wondered if I could do that. I could not summon up any incentive to keep at it- no emotionally distant father to impress, no personal hurts to avenge or assuage, no deep seated need to add value to my life. Finally, I rationalized that I had done enough for one day, it was only training after all, I had nothing to prove, etc., etc. and I shrugged off the rest of the run and went home to a cold shower, ice cold glass of Coke, and a 4 egg frittata. Now, Alberto and Dave would probably have summoned some desire from deep down, gutted it out, run all the way, and spent themselves completely, to the point of near death, if necessary, just to prove, well, whatever they were trying to prove.

      On reflection, I wonder if I have it in me to complete an ironman, a question that comes up frequently these days, especially after such a difficult session. Where can I summon up the will, drive, desire to leave it all out on the course in order to finish? Certainly not from a rotten childhood. As I said at the start, my parents ruined me for greatness. On the other hand, I think I have done OK with my life and the question becomes, would I exchange my life for that of a Salazar or Scott? Not in a million years.

Hopefully, 6 more weeks of hard training and some adjustment in my thinking will get me through.

*Duel in the Sun, Alberto Salazar, Dick Beardsley and America's Greatest Marathon by John Brant
  Iron War, Dave Scott, Mark Allen & The Greatest Race Ever Run by Matt Fitzgerald

A brick in the bank, or, you have to be certifiable to do this to yourself

The origins of a word can be mystifying. In triathlons, a “brick” is the term used to describe when a triathlete does two or more of the disciplines in a training session, back to back. I have read that the word “brick” comes from a melding of the words “bike” and “run”. Okaaay, but why “brick”? Why not “bun”? Or, better yet, “burn” or “brith”. Either of those would better describe the pain/discomfort of doing a bike/run back to back. What if you do a swim and bike? Would that be a “swike” or a “bwim”? Would a swim and run be a “rim”? I think this is going to give me a headache!

Not everyone thinks bricks are a good idea. They feel that as long as you can do any one of the disciplines on any given day before the triathlon, you will be able to put them together on the day of the event. To do more puts one at risk of injury.  I think I will feel better having a least an idea of what it feels like to do a few bricks. It is hard to prepare yourself for something you have never done before. Of course, if the brick goes well, it can be a great confidence booster. Then again, if it doesn’t, it can be deflating.

Today, I did my first “century”, a 100 mile bike ride (no wondering where that term can from) in training. The first half went great. It was cool, shady most of the way, and I made the turn around at 53 miles in 3 hours, feeling great. Shoot, this is going to be a piece of cake. Then came the return. The sun was now fully up, it was edging toward the 97 degree high for the day, and I was heading into a 7 mph headwind. It may not sound like much, but any headwind is a pain in the butt, and when you are hot and tired, it is a royal pain in the butt.  (this is what you get when you Google images of a "royal pain in the butt") By the end, I was just trying to ration my energy for a short run at the end, just to see how the legs felt and what I might have left “in the tank” so-to-speak for a run. My total was actually just over 107 miles at an average of 16.8 mph- way faster than I anticipated. My total moving time was 6 hrs 32 min with a total elapsed time of 7 hrs 15 min (that included stops for water, ice, and nourishment). I packed 10 packages of GU  energy gels, 1 chocolate chip granola bar, a bag of Stinger soft energy chews, and 20 Salt Stick capsules. It wasn't nearly enough. I had to buy a big bag of gummie chews for the last hour. Fluids were 2 water bottles plus another 48 oz of water that I bought and a 20 oz Gatorade to make up for running out of Salt Sticks.

 

Between the energy sapping heat, sore-tired legs, and tight-sore neck and back a single fact was driven undeniably home: you have to certifiably crazy to do an ironman triathlon; to even want to do one. If I ever doubted that, today erased those doubts. I didn't even do a real run; I mostly walked. And, it was only 3 ½ miles, not 26.2. And, I didn’t do a 2.4 mile swim before the bike ride. Yes, insanity pretty much sums it up.

The funny part- not “ha ha” funny, but odd funny- is that it really isn’t fun either. I don’t think you do a full ironman for fun. It is more about the challenge. To see what you can do; what you’re capable of. It is a test of your limits. It seems to me a shame to go through life and never push yourself to see what you are made of. That, and there is, hopefully, a cool finishers medal at the end. Extrapolating from my situation, I suspect that a lot of people do the training, like me, and then go into an ironman not really sure they will actually finish it, like I think I might.

In a scene from the Karate Kid, Daniel-san confides his fears to Mr. Miyagi, as he approaches the big karate tournament, at which he expects to have his head handed to him by the bullies of the Cobra Kai dojo. I remember Miyagi’s response: “trust the quality of your training”.   Well, today was a “quality” day, and the first brick. Hopefully, the past 9 months of training plus the 6-7 weeks to come will be enough. I hope so. Time will tell.......